Euthanasia Procedure Research Articles

Brachial plexus nerve injury and repair in a rabbit model part II: Does middle trunk injury result in loss of biceps function while repair results in recovery of biceps function.

There is conflicting anatomic and innervation data regarding the rabbit brachial plexus injury model. This study aims to validate a rabbit brachial plexus injury model. We hypothesize the middle trunk (C6, C7) is the primary innervation of the biceps, and when cut and unrepaired, would demonstrate lack of recovery and when repaired would demonstrate evidence of recovery. Twenty two male New Zealand white rabbits (3-4 kg) underwent unilateral surgical division of the middle trunk. Five rabbits were randomly assigned to the "no-repair" group while the remaining 17 rabbits underwent direct coaptation ("repair" group). Rabbits were followed for 12 weeks, with ultrasound measurement of biceps cross-sectional area performed preoperatively, and at 4, 8, and 12 weeks postoperatively. At a euthanasia procedure, bilateral compound muscle action potential (CMAP) and isometric tetanic force (ITF) were measured. Bilateral biceps muscles were harvested and wet muscle weight was recorded. The operative side was expressed as a percentage of the non-operated side, and differences between the no repair and repair rabbits were statistically compared. The repair group demonstrated significantly higher CMA (23.3 vs. 0%, p < .05), ITF (25.6 vs. 0%, p < .05), and wet muscle weight (65.8 vs. 52.0%, p < .05) as compared to the unrepaired group. At 4 weeks postoperatively, ultrasound-measured cross-sectional area of the biceps demonstrated atrophy in both groups. At 12 weeks, the repair group had a significantly larger cross-sectional area as compared to the no-repair group (89.1 vs. 59.3%, p < .05). This injury model demonstrated recovery with repair and lack of function without repair. Longer survival time is recommended for future investigations.

Euthanasia via CO2 inhalation causes premature cortical granule exocytosis in mouse oocytes and influences in vitro fertilization and embryo development.

Generation of high quality mouse metaphase II oocytes is an integral part for efficient in vitro fertilization (IVF), and subsequent embryo production for reproductive studies and genome banking. The main objectives of this study were to investigate the impact of various euthanasia methods on IVF, embryo development, and subcellular structures of MII mouse oocytes. Following superovulation regimen, female mice were euthanized by high flow CO2 (H CO2 ), low flow CO2 (L CO2 ), or cervical dislocation (CD). The MII oocytes obtained from these mice were evaluated for subcellular integrity by assessing their cortical granules and F-actin. Furthermore, fertilization and subsequent embryonic development competence up to blastocyst stage were also evaluated in vitro. The oocytes collected from females euthanized by CD resulted in significantly higher two-cell development rates (p = 0.028) and subsequently lead to in higher embryo development rates (p = 0.027) compared with oocytes from females euthanized by L CO2 . The cortical granule integrity analysis revealed significantly higher rate of premature cortical granules exocytosis (PCGE) for L CO2 group compared with CD and H CO2 groups (p < 0.001). These data collectively suggest that CO2 associated PCGE during euthanasia procedure is the main cause of decreased IVF rates and CD is the optimal euthanasia method for the purpose of obtaining good quality MII oocytes for mouse IVF and other reproductive studies.

Правове регулювання евтаназії: міжнародний досвід

Стаття присвячена вивченню міжнародного досвіду правового регулювання евтаназії. У статті досліджено зміст поняття «евтаназія», виокремлено його складові, здійснено класифікацію, систематизовані позиції противників і прихильників легалізації евтаназії, проаналізовано правові підстави запровадження евтаназії в контексті реалізації права на життя, обґрунтовано доцільність розвитку паліативної допомоги як альтернативи евтаназії.

EUTHANASIA OR PALLIATIVE CARE: LEGAL PRINCIPLES OF THE IMPLEMENTATION IN THE CONTEXT OF THE REALIZATION OF HUMAN RIGHTS TO LIFE

Introduction: The right to life - is natural inherent human right, the fundamental principle of the existence of mankind, recognized by all civilized countries. It is enshrined in numerous international and national legal acts as the most important benefit of a man. However, there are discussions about the use of euthanasia. Therefore, the problem of the legalization of euthanasia requires careful study. The aim: The purpose of this article is to analyze and systematize existing problems of the legalization of euthanasia. The main objective of the article is to study the legal grounds for the introduction of euthanasia in the context of realizing the right to life, to study the content of palliative care, to distinguish the barriers to its development, and to formulate propositions for their elimination. Materials and methods: Theoretical (analysis, synthesis, generalization, systematization, etc.) and empirical methods (observation, survey, classification, etc.) were used in the course of the research. Results: The author has revealed the negative attitude of medical staff to the possibility of using different forms of euthanasia during the study. The reasons for the positive attitude of patients, who were in the thermal stage to the euthanasia, have been determined. It has been established that the correction of most causes leads to a significant reduction in the percentage of positive attitude to euthanasia. The arguments of opponents and supporters of the legalization of euthanasia procedure have been analyzed. On this basis the author has proved the objective absence of legal grounds for the legalization of euthanasia procedure and direct violation of human rights to life. Conclusions: The author has proved the expediency of the development of palliative care as an alternative to euthanasia, has outlined the obstacles to its development, has offered to develop regulatory base for the legal regulation of the provision of palliative care, to establish the National Coordination Council on palliative and hospice care, to form the system of state control over the quality of provision of palliative care and observance of the rights of patients.

Assessing circumstances and causes of dairy cow death in Italian dairy farms through a veterinary practice survey (2013–2014)

A questionnaire survey about on farm dairy cow mortality was carried out among veterinary practitioners in Italy between January 2013 and May 2014. The study aimed at investigating the main circumstances of death in dairy cows (euthanasia, emergency slaughter or unassisted death), the primary causes and the risk factors of death. Out of 251 dead cows involved (across 137 farms), 54.6% died assisted and 45.4% were found dead. The main causes of death were metabolic/digestive disorders (22.3%) and mastitis/udder problems (17.1%), while in 14.7% of all cases, reasons of death were unknown. From the univariable generalised linear mixed models, dry cows showed a significantly higher odds to die unassisted compared to lactating cows (OR=3.2); dry cows also had higher odds of dying from unknown reasons (OR=11.7). Season was not significantly related to the risk of dying unassisted and for unknown reasons, but during the summer (characterised by hot and muggy weather in Northern Italy) cows died mostly for problems at calving. 54.2% of cows died during the first 30days in milk (DIM). Half of the multiparous cows that died, died in the first 29.5 DIM, while half of the primiparous cows that died, died in the first 50 DIM. Results pointed out that, especially in dry cows, around calving and during the summer, some failure in management practices and daily inspections may occur. Improvements should be done in monitoring activities and in recognising early symptoms of diseases among stockperson. In addition, in case of diagnosed diseases with poor prognosis, euthanasia procedures should be implemented to prevent cows from dying unassisted.

Shelter medicine: a new especialty

Shelter Medicine is a new branch in Veterinary Medicine which aims to improve the health and welfare of animals that do not have a home and live at risk. The specialty was created in the United States of America (USA) with this denomination, and intended the population control of dogs and cats through sterilization, reintegration and socialization of abandoned animals, handling feral cats and control of common diseases in shelters. In this sense, Shelter Medicine proposes a solution to the rampant increase in the non domiciled animals population and, hence, the spread of zoonotic diseases. In addition, to improve the quality of life of those animals, by reducing the euthanasia procedures, damage to property and assault cases

The efficacy of clove oil as an anaesthetic and in euthanasia procedure for small-sized tropical fishes

Clove oil is used as a fish anesthetic because it is a natural and inexpensive product with low toxicity risks. The goal of the present study was to determine the appropriate concentration of clove oil for small-sized tropical fish to be used in mark-recapture studies or when individuals are to be sacrificed. We applied three different clove oil concentrations (D1=0.05 mL, D2=0.10 mL and D3=0.20 mL per 500 mL of water) on three small-sized fish species. We found a negative relationship between induction time and treatment for two species (Hyphessobrycon sp.1 and Hemigrammus sp.), while concentration was unrelated to recovery time. Fish body length was positively related to induction time in the D2 treatment for Hemigrammus sp., and negatively for Hyphessobrycon sp.1 in the D1 treatment, but was unrelated to recovery time for three species and treatments. Mortality rates varied across treatments, but higher rates were observed with higher clove oil concentrations. We conclude that 0.05 mL of clove oil per 500 mL of water is the most efficient dose for studies where fish will be released back to their natural habitats, while 0.20 mL of clove oil is recommended for studies that require fish euthanization for further laboratory analyses.

Assistance in Dying: Deepening Understanding of Novel Ethical Issues in Psychiatry

Assistance in Dying: Deepening Understanding of Novel Ethical Issues in Psychiatry

A Defence of Conscientious Objection in Medicine: A Reply to Schuklenk and Savulescu.

In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious objection in publicly-funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access.

Nurses’ Opinion About Euthanasia in East Azerbaijan Province, Iran

Background: Euthanasia is one of the important challenges in the field of end of life care. There are few studies investigated the attitude of Shiite Muslim nurses about different aspects of euthanasia. Objectives: The aim of present study was to investigate the attitude of Iranian Shiite nurses about different aspects of euthanasia in East Azerbaijan Provence, Iran, 2012. Patients and Methods: In this descriptive study, 209 nurses (census sampling method) from 6 educational hospitals in East Azerbaijan Province were participated. The attitude of nurses was investigated with Euthanasia Attitude Questionnaire, which is a 31-item scale. This scale investigate the attitude of nurses in 5 domains, including general attitude (3 items), legal and religious issues (5 items), end of life care (8 items), euthanasia decision making (8 items), and attitude toward different types of euthanasia (7 items). Descriptive statistics were used for data analysis using SPSS software (ver. 13). Results: Participants had a negative attitude towards all aspects of euthanasia. They reported that they would not participate in euthanasia procedure even this procedure was accepted by religious leaders and legal authorities. They believed that caring of end of life patients is a burden but this is not a reason for euthanasia and also they did not consider patients or their relative as decision makers for euthanasia. In addition, participants rejected all types of euthanasia. Conclusions: Iranian nurses in East Azerbaijan Provence have negative attitudes toward different aspects of euthanasia and this negative attitude is not related to religious or legal issues. So, searching for the reasons for such an attitude needs more investigation.

Nurses’ Opinion About Euthanasia in East Azerbaijan Province, Iran

Background: Euthanasia is one of the important challenges in the field of end of life care. There are few studies investigated the attitude of Shiite Muslim nurses about different aspects of euthanasia. Objectives: The aim of present study was to investigate the attitude of Iranian Shiite nurses about different aspects of euthanasia in East Azerbaijan Provence, Iran, 2012. Patients and Methods: In this descriptive study, 209 nurses (census sampling method) from 6 educational hospitals in East Azerbaijan Province were participated. The attitude of nurses was investigated with Euthanasia Attitude Questionnaire, which is a 31-item scale. This scale investigate the attitude of nurses in 5 domains, including general attitude (3 items), legal and religious issues (5 items), end of life care (8 items), euthanasia decision making (8 items), and attitude toward different types of euthanasia (7 items). Descriptive statistics were used for data analysis using SPSS software (ver. 13). Results: Participants had a negative attitude towards all aspects of euthanasia. They reported that they would not participate in euthanasia procedure even this procedure was accepted by religious leaders and legal authorities. They believed that caring of end of life patients is a burden but this is not a reason for euthanasia and also they did not consider patients or their relative as decision makers for euthanasia. In addition, participants rejected all types of euthanasia. Conclusions: Iranian nurses in East Azerbaijan Provence have negative attitudes toward different aspects of euthanasia and this negative attitude is not related to religious or legal issues. So, searching for the reasons for such an attitude needs more investigation.

Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study

ObjectivesTo identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research.DesignRetrospective analysis of data obtained through medical file review.SettingOutpatient psychiatric clinical setting in...

Transitional cell carcinoma of urinary bladder with metastasis in lumbar vertebrae and spinal cord compression in an ocelot(Leopardus pardalis)

This paper reports a case of nonpapillary and infiltrative transitional cell carcinoma (TCC) of the urinary bladder with metastasis of lumbar vertebrae and spinal cord compression in an adult female ocelot (Leopardus pardalis), from the Mato Grosso state, Brazil. The ocelot had pelvic limb paralysis and skin ulcers in the posterior region of the body and was submitted to euthanasia procedure. At necropsy was observed a multilobulated and irregular shaped, yellowish to white nodule in the urinary bladder. The nodule had a soft consistency and arised from the mucosa of the urinary bladder extending throughout the muscular layers and the serosa. Nodules of similar appearance infiltrating the vertebral column the at L6 and L7 vertebrae with corresponding spinal canal invasion were also observed. The histological evaluation showed epithelial neoplastic proliferation in the urinary bladder with characteristics of nonpapillary and infiltrative TCC, with positive immunohistochemical staining for pancytokeratin, and strong immunostaining for cytokeratin of low molecular weight, and weak or absent labeling for high molecular weight cytokeratin. This is the first report of TCC of urinary bladder in ocelot in Brazil.

Transition health

There is an urgent need for dairy practitioners to become more involved in managing the health of transition dairy cows on many large dairies. Veterinarians can become involved at the level of properly diagnosing and treating disease and at the level of disease prevention. Specific tools that veterinarians can use include objectively monitoring transition-cow health with an emphasis on monitoring early lactation death loss, getting into post-fresh pens to observe disease diagnosis and treatment, evaluating on-farm euthanasia procedures, evaluating handling and care of downer cows, encouraging proper recording and monitoring of transition-cow diseases, using on-farm data to identify risk factors for disease, and intensively monitoring key health outcomes such as hypocalcemia, ketosis, and lameness. The veterinarian’s role in transition cow health monitoring may be enhanced by establishing ongoing monitoring programs, which provide longer-term involvement than troubleshooting only.

Penetrating captive-bolt euthanasia of goats

Anatomical placement of a penetrating captive bolt device (PCB) when euthanizing animals is critical to ensure vital structures are damaged, thereby rendering animals immediately unconscious and death occurring without a return to sensibility. Although PCB are an approved method for euthanizing small ruminants, the current peer-reviewed literature contains discrepancies regarding the appropriate anatomic site to be used for euthanasia procedures. Currently, 2 important documents, American Veterinary Medical Association’s 2013 Euthanasia Guidelines (AVMA) and World Organization for Animal Health’s Terrestrial Code (OIE), are in disagreement over the recommended site for captive bolt placement in small ruminants. The AVMA 2013 guideline recommends use of a frontal site high on the forehead aiming towards the foramen magnum as an alternative site in horned goats. The OIE recommends the frontal site be used for gunshot only. Exact positioning of a PCB at the poll is poorly described in the literature. The objective of this study was to determine the optimal anatomical site for PCB placement in horned and polled goats to ensure brainstem disruption consistently occurs.

When family violence takes subtle forms: A narrative from a Dutch context (A response to CH Thesnaar)

Domestic abuse is of all times and all places, and depending on contextual factors, it will take many different forms. Christo Thesnaar’s contribution elsewhere in this volume, about human dignity, domestic abuse, and domestic violence provides an impressive insight in the vicious circle of abuse from a South African context. In the case of Ellen Pakkies, this emanates into the utter tragic of a mother killing her son. After a long history of son-mother abuse, Ellen is visited by her son who once again displays his usual state of apathy. This time she decides to make him talk once and for all, so she puts a rope around his neck and tightens it. He swears at her, tries to grab a plank off the floor, but this time she is in charge. She will teach him a lesson. And before long, she has killed him. One of the reasons why the story is so heartbreaking is that it runs counter to everything we, as parents or as children, conceive to be the normal course of events in families. It will not be hard to find similar examples of domestic violence in other developed countries. Substance abuse is widespread in Europe, especially amongst citizens with a low socio-economic status. Still, the extent of violent crimes in South Africa and the gap between the socio-economic classes there justify the conclusion that the story presented by Thesnaar is much more typical for a South African context than it is for a European one. And there is another element in this account which strikes as un-European: the story told, the heuristics used, the analysis made, and the questions asked, illustrate the presence of a living tradition of highly qualified Protestant theology. In this contribution, we present a story of abuse taken from a radically different context which, on a closer look, is strikingly similar to the one recounted by Thesnaar. It is taken from the context of a euthanasia procedure, i.e., an assisted death of a patient by his doctor, at his request. We will start by shortly explaining the legal and medical-ethical framework surrounding the story. After the narrative is told we conclude by raising three points of discussion.

Isoflurane reduces motile sperm counts in the Sprague-Dawley rat

Animal and care use practices are constantly evolving. These can have unexpected consequences on the data collected from such procedures. One example is the recent change in our animal facility, based on recommendations from the Newcastle Consensus Meeting on Carbon Dioxide Euthanasia of Laboratory Animals, from CO2 to isoflurane for anesthesia. The current study was conducted to determine the effects of isoflurane on sperm motility, as compared to two different CO2 euthanasia procedures. Sperm motility was evaluated after euthanasia by a standard 5-minute CO2 euthanasia procedure, an extended 10-minute CO2 euthanasia procedure, or by isoflurane anesthesia followed by exsanguination (iso/exsanguination). The 5-minute CO2 procedure produced sperm motility of 94.3 ± 1.7% motile sperm with 65.6 ± 16.8 sperm/field. By comparison, iso/exsanguination reduced that count to 3.3 ± 2.3 sperm/field and only 60.7 ± 32.0% motile sperm. The reduction in sperm motility after iso/exsanguination appeared to have been due primarily to the reduction in the number of sperm expelled from the vas deferens (3.3), compared to that after 5-minute CO2 (65.6). This reduction in number of sperm available for evaluation, in the presence of a constant level of background debris, which was counted by the computer optics system as nonmotile sperm, resulted in an apparent reduction in motility. Using the extended 10-minute CO2 procedure produced sperm data in between the other two extremes: 77.6 ± 36.1% motile sperm with 34.6 ± 28.3 sperm/field. The results of this study support the hypothesis that isoflurane inhibits contraction of the smooth muscle of the vas deferens, resulting in a decreased number of expelled sperm. Given these findings, it is important that careful consideration be taken to select an appropriate anesthesia/euthanasia method.

Unbearable suffering of patients with a request for euthanasia or physician‐assisted suicide: an integrative review

In the legal performance of the euthanasia procedure, unbearable suffering, one of the requirements of due care, is difficult to assess. Evaluation of the current knowledge of unbearable suffering is needed in the ongoing debate about the conditions on which EAS can be approved. Using an integrative literature review, we evaluated publications with definitions of suffering in general or in end-of-life situations and with descriptions of suffering in the context of a request for EAS. From the 1482 citations identified, we included 55 publications: 20 articles about definitions of suffering and 35 empirical studies on suffering. We found no definition of unbearable suffering in the context of a request for EAS. Qualitative patient-centered studies revealed the most motivations, and the most motivations named by only one of the three parties involved. The studies of relatives were limited, mainly quantitative and retrospective. We found no studies that brought together the views of the patients, relatives, and healthcare professionals. There is no generally accepted definition of 'unbearable suffering' in the context of a request for EAS. On the basis of the articles reviewed, we propose the following conceptual definition: 'Unbearable suffering in the context of a request for EAS is a profoundly personal experience of an actual or perceived impending threat to the integrity or life of the person, which has a significant duration and a central place in the person's mind'. Further patient-centered qualitative research into suffering is needed to clarify this definition.

Organ Procurement After Euthanasia: Belgian Experience

Euthanasia was legalized in Belgium in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident. Between 2005 and 2007, 4 patients (3 in Antwerp and 1 in Liège) expressed their will for organ donation after their request for euthanasia was granted. Patients were aged 43 to 50 years and had a debilitating neurologic disease, either after severe cerebrovascular accident or primary progressive multiple sclerosis. Ethical boards requested complete written scenario with informed consent of donor and relatives, clear separation between euthanasia and organ procurement procedure, and all procedures to be performed by senior staff members and nursing staff on a voluntary basis. The euthanasia procedure was performed by three independent physicians in the operating room. After clinical diagnosis of cardiac death, organ procurement was performed by femoral vessel cannulation or quick laparotomy. In 2 patients, the liver, both kidneys, and pancreatic islets (one case) were procured and transplanted; in the other 2 patients, there was additional lung procurement and transplantation. Transplant centers were informed of the nature of the case and the elements of organ procurement. There was primary function of all organs. The involved physicians and transplant teams had the well-discussed opinion that this strong request for organ donation after euthanasia could not be waived. A clear separation between the euthanasia request, the euthanasia procedure, and the organ procurement procedure is necessary.

How Patients and Relatives Experience a Visit from a Consulting Physician in the Euthanasia Procedure: A Study Among Relatives and Physicians

This study investigated the impact of a visit from a consulting physician on the patient and the relatives during the euthanasia procedure in The Netherlands. Data on experiences with the consultant's visit were collected from 86 relatives and 3,614 general practitioners, who described their most recent request for euthanasia or physician-assisted suicide. More than three-quarters of the patients experienced the visit as they had expected, or became more positive. Although about 1 out of 5 patients had negative experiences, this study indicates that, in general, a visit from a consulting physician is not perceived to be burdensome for patients.